Bolivia

Letter from Dr. Gieser:

Dear Friends:

A recent trip to Bolivia is best described as refreshing. This was our first trip to South America. I spoke at the annual meeting of the Bolivian Ophthalmology Society and examined patients at the Instituto Nacional de Oftalmologia in LaPaz. Marge painted a 15 foot by 8 foot mural of Christ healing Jarius’ daughter, at the Hospital Hollandaise in El Alto, a city of 850,000, about 45 minutes from Central LaPaz. This neglected city has only 160 hospital beds and is known as the city of "bad dreams." We were with a group led by Enrique ViaReque, an anesthesiologist from Central DuPage Hospital, who is from Bolivia. The group is sponsored by the Diocese of Chicago and seeks to help the poor in Christ’s name. Two plastic surgeons repaired 6-8 cleft lips each day and also revised burn scars. The incidence of cleft palates is quite high amongst the Indian population. A neuro-surgeon and an ob/gyn specialist completed the team.

Bolivia is three times the size of Great Britain yet has only 8 million people. The geography ranges from the rain forests in the east to the great mountain peaks of the Andes. LaPaz, the highest capital in the world at 13,000 feet, is located in a large gash in the Altiplano, high in the Andes. The one million inhabitants fill its gash. Viewing the city at night from the edge of this bowl reminds you of viewing a city from an airplane.

We spent a day at Lake Titicaca, the highest lake in the world. It is 120 miles by 60 miles. It is essentially in the wilderness. A few small towns dot its borders but the countryside is empty. I saw two or three sailboats and four or five fishing boats on a Sunday holiday. The population is Indian and they are dressed colorfully.

According to Marge, the only place we have visited that is as photographically interesting in India. The contrast is startling, however. India is much more intense in its sounds, smells, and density of population.

We are quite ignorant of South American ophthalmology. There are great training centers in Brazil, Argentina, and Chile, where the Bolivians go for subspecialty training. The subspecialty cadre is starting to build in this country, which has about 150 ophthalmologists. This is in stark contrast to Ghana, where we visited last year, with only eight ophthalmologists for 17 million people. The Eye Institute is spotless, the dress formal, with suits and ties in order. I have never been to a developing country where they use examining chairs that recline and hold a slit lamp. This is so simple but would save time with each patient.

All developing countries do not pay their academics adequately so they must have a private practice to support themselves. All the faculty goes to their private offices in the afternoon, limiting the productivity of a teaching center. Unlike many places I have visited, the faculty started promptly at 8:00 a.m. and spent the entire morning at the hospital. About 100 patients are examined each day at the Eye Institute. The stimulus to study brought on by annual board exams and persistent resident directors that US residents enjoy is missing. I gave a lecture each morning and appreciated the interest in learning from the staff.

Each day our visiting group started with morning prayers. The morning after the first day of surgery brought a sad report that a malnourished baby had cleft palate surgery, continued to bleed, and finally aspirated. The death of this child brought great sadness to the group. A tearful time of prayer united us.

It was a delight to have our oldest granddaughter Haley, who is now 14, with us. Witnessing the crises involved in medical care, working in a soup kitchen for the poor, and learning a culture by direct inspection is more educational than two weeks in school.

An Argentine doctor, Che Guevara, made a big mistake by coming to eastern Bolivia after success in Cuba, in the early 1960s. he chose a semi-tropical, sparsely populated area where the locals enjoyed a hermit-like, individualistic life and were not in the least bit interested in a socialist revolution. His band of revolutionaries was soundly beaten by the Bolivian army and he was killed. Had he chosen the central Altiplano regions where the miners died early deaths in neglected mines and the land-starved peasants fought to live, he may have succeeded.

The climate in LaPaz is amazingly stable. The temperature varies only about 15 degrees C between winter and summer. The air is always crisp and cool. The buildings are not heated and you learn to dress warmly.

Again, it is healthy to be a foreigner for a few weeks. It is good discipline to give lectures and a shocking experience to be reminded of the unique life we enjoy in America.

God bless America.

Cordially,

Richard G. Gieser, MD